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Innovation fund overview

Nurses and Midwives (Queensland Health and Department of Education) Certified Agreement (EB10) 2018 established the $10 million Innovation Fund to fund projects to develop and implement models of care that are innovative, flexible and which address emergent or unmet health care needs, with a particular emphasis on the way in which nursing or midwifery led models can positively address the social determinants of health. The Innovation Fund projects are the focus of this Nursing and Midwifery Showcase, with interviews with the Project Leads detailing their work, the findings, challenges and ongoing outcomes from the projects.

The context of the Innovation Fund projects is one of nursing and midwifery excellence at Queensland Health. This Showcase Series demonstrates the value of nursing, rather than the cost, in ensuring patient safety and pursuing industrial and professional partnerships. The interviews below provide an overview of the Innovation Fund.

Dr Jeanette Young, Chief Health Officer

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Hello. I'm Dr. Jeanette Young, Queensland's Chief Health Officer.

I'm speaking today to acknowledge the fantastic work of nurses and midwives across the entire state of Queensland. Our nurses and midwives are the core of our state's health service. They care for Queenslanders across the length and breadth of our state. From Badu Island in the Torres to Camooweal and Thargomindah in the far west, all along the Pacific Coast and everywhere in between, you'll find Queensland Health's nurses and midwives caring for our communities.

The Nurses and Midwives EB10 Certified Agreement established a $10 million Innovation Fund to fund projects to develop and implement models of care that are innovative, flexible and which address emergent or unmet healthcare needs with a particular emphasis on the way in which nursing or midwifery-led models can positively address the social determinants of health.

This showcase celebrates the wonderful work of Queensland Health's nurses and midwives and demonstrates the value of nursing and midwifery within our healthcare system. A key criterion of the Innovation Fund was support for projects that progress nursing and midwifery-led models of care. The relationship between patient and nurse or mother and midwife is one of trust and care. The projects of the Innovation Fund place that privileged relationship at the centre with nurses and midwives leading the care of their patient or mother. Those of us who work in healthcare have always known the experience, clinical knowledge, sense of duty, and caring nature within the nursing and midwifery workforce.

The focus that COVID-19 has brought to our healthcare service has highlighted to the public the value that nurses and midwives bring to Queensland Health and our broader health system. This has never been more evident than through our COVID-19 vaccination program, which is reliant on our skilled nurses and midwives across Queensland showing their great willingness to participate in getting our population vaccinated against COVID-19. You are all part of Queensland's front line of defence, making sure as many of our community is protected from this virus for when Queensland has community transmission.

Our nurses and midwives are not just integral to our health system, but our community as well as leaders, role models, and carers. The actions of nurses and midwives in all roles across Queensland directly impacts patients, their experience, and their health outcomes. I'm immensely proud of the Queensland Health nurses and midwives, particularly during 2020 and 2021. As we so often hear, the events of the last 18 months are unprecedented and the contribution of nurses and midwives to support our families, our friends, our people, through all of their interactions in our communities during this time has been ongoing, caring, and courageous.

Shelley Nowlan, Chief Nursing and Midwifery Officer

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Hi. My name is Shelley Nowlan, Chief Nurse and Midwifery Officer here in Queensland.

It is a really lovely invitation that I've had today to speak about the Innovation Fund, the enterprise bargaining EB10 work that we have done collaboratively across the state here in Queensland, in collaboration with the Queensland Nurses Midwifery Union, but also in collaboration with my colleagues, the executive directors of nursing and midwifery services.

The EB10 fund on innovation, a $10 million commitment by Queensland Health was really well needed. Why do I say well needed? Well, nurses and midwives are the foundation of the health care system. They are here 24 hours a day, seven days a week, and they live and breathe and work in the communities across Queensland.

The EB10 Innovation Fund gave us the opportunity, gave nurses and midwives across Queensland the opportunity to look at the services that they provide and where they could make profound differences in regards to the services that they provide each and every day. The $10 million investment was solution orientated. It focused on the sustainable development goals and on vulnerable communities across our state. Nurses and midwives, each and every day provide solutions to very difficult and complex services in the most complex of systems, our health care system.

The Innovation Fund really focused on how nurses and midwives that work in the communities could make differences to those communities, by having the opportunity to lean forward and to focus on innovation when nurses and midwives lead that care. What we found was that the nurses and midwives worked across the continuum in interdisciplinary and integrated care teams, in primary health care sectors, in community sectors and in the acute sector to come up with solutions.

Now, those solutions were co-designed in many instances with the consumers, with the patients that they care for each and every day.

We saw Aboriginal Torres Strait Islander care significantly lifted, particularly in midwifery areas where it was focused on a hundred percent of that workforce being Aboriginal Torres Strait Islanders, working with their communities to come up with solutions particularly about birthing on country. The Gold Coast Jarjums project actually was essential and really innovative, but, hey, it really hit a tone with the community and what was well needed.

We also seen the solutions focused on mental health. Mental health, where we find people that come to our emergency departments and become the missing middle. The missing middle in the sense that they weren't quite an emergency and or they weren't connected to community care. So our co-responder mental health models actually took it out of the emergency department into community spaces, working collaboratively across sector with the Queensland Police Service or the Queensland Ambulance Service to actually reach out into the homes of people where they were displaced and in urgent need of care around mental health, and were linked to community health services, but really focused on that acute dynamic that was caring at the start of their deterioration in their care, and then focused on the long term connectivity with integrated care within the community. If we have more of these, we actually keep those patients out of our emergency departments and rely on emergencies to address those urgent needed acute episodes and focus on community wellbeing.

So there are two examples of where nurses and midwives have led services that particularly brought care out to the community and not in acute hospitals. So let's not look at the past, let's look to the future. We know here and now, we are in the midst of major reform, particularly with the pandemic. So what I challenge you is now to consider what has come out the best, what has been best practise and what has been new practise post COVID, let's embed it, and let's ensure that we move forward with better health care for our health professionals and for the patients.

So as the chief nurse and midwifery officer here in Queensland, I'd like to, first of all, thank the lobbying of both our executive directors of nursing midwifery services and the QNMU to actually really get involved and launch these projects. $10 million is not a lot of money, but when you have a look at the outcomes of these 19 projects, you will see the value and the investment has been achieved four-fold. I also want to thank the project leads, the nurses and midwives that put their ideas forward that really connected with their communities and their colleagues to actually bring these innovations and solutions to clinical care to the forefront. They lifted, they were invested in themselves in regards to project methodology, evaluation methodology, and wow, have they shone. So thank you.

Thank you for everyone who's involved and let's make Queensland a better place with nursing and midwifery led care. But now I call you to action. I call all of my healthcare professions, my colleagues, and those who work alongside nurses and midwives, be brave, put your best foot forward and bring those ideas to the forefront. You never know those ideas are just our future innovations. I hope that you found this information from the nursing and midwifery showcase very informative. Make Queensland a better place to work and a better place to live. Bring the care to the forefront, nursing and midwifery led care.

Beth Mohle, Union Secretary of the Queensland Nurses and Midwives’ Union

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Hello, my name's Beth Mohle, and I'm Secretary of the Queensland Nurses and Midwives' Union.

I am so excited to be here today to talk to you about the Queensland Health and QNMU EB10 Innovation projects for Nursing and Midwifery. This is really, really exciting for us. When we were negotiating the EB10 Agreement a few years ago, we really wanted to showcase the innovation that nurses and midwives do every day of the week. So, as part of the EB, we funded a $10 million fund, where we could put in applications from across the state of the magnificent projects that nurses and midwives wanted to run on the ground in their hospital and health services to demonstrate not only the significant value that they contribute every day, but also address the social determinants of health. We know, day in, day out, nurses and midwives make a real difference in their communities, and this is what these projects were about.

Our EB10 negotiations, and indeed the implementation of our EB Agreements, is done in what's known as an interest-based, problem-solving approach. In that approach, what we do is Queensland Health and the QNMU sit down together, and we focus on what are our shared interests, what we want to work on so we can make a bigger difference together, because if we focus on what we agree are really important issues, what are the problems that need to be solved, then we are so much more powerful if we work on these together. So, this interest-based, problem-solving approach was really foundational to our Nursing and Midwifery Innovation projects, and the significant discussions that we had in the negotiation of the Agreement really put a lot of important legwork into defining what we wanted to achieve in these projects.

What we wanted to demonstrate was the value and the contribution that nurses and midwives make, so a big part of these projects is to incorporate an evaluation. So, there were 19 fantastic projects that were delivered from across the state, and the funding was for $10 million in total for all of those, so we had to really spread the money very, very far. But the work that was able to be done by these 19 projects was truly magnificent, and we're very excited to be able to showcase this to you today. The Nursing and Midwifery Innovation projects are absolutely linked to the QNMU Professional Practice Standards. These standards are the elements of what makes up a positive practice environment for nurses, and one of the critical elements is Standard Number Five, which states that nurses and midwives must be involved in research and innovation, and that is what our EB10 Nursing and Midwifery Innovation projects are all about. They showcase how important it is that nurses and midwives are involved in research and innovation every day, because by doing that, we make a difference to our communities and to our professions. I hope you found this presentation on the Nursing and Midwifery Showcase Series informative. Please make sure you take the time to check out other examples of nursing and midwifery excellence from Queensland Health.

Mary Chiarella, Professor Emerita of the University of Sydney

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Hi, my name is Mary Chiarella. I'm Professor Emerita at the University of Sydney and Adjunct Professor at the University of South Australia.

I've been involved in several aspects of this EB10 over the years, and have followed these innovation projects with great interest. I'm delighted to have read the project reports and to have seen some of the videos already.

Before I begin, I would like to acknowledge the traditional custodians of all the lands on which we meet and to pay my respects to elders, past, present and emerging. I am on the lands of the Gadigal of the Eora Nation, and I recognise that ancient and ongoing connections to the land, waterways and air.

So eight key overarching themes emerged for me from these magnificent projects. I'll list them first and then I'll speak briefly to each of them in turn. Five relate to patient outcomes and three relate to staff and workforce outcomes. Although I'm quite sure that all eight would lead to improved staff and patient outcomes and satisfaction.

So the themes are as follows. They all address populations whose needs are under served for a range of reasons. They all improve access to care, whether as inpatients or within the community. Many are concerned with culturally and emotionally appropriate care. Many of them lead to avoidance of hospital admissions, thus reducing inpatient costs. Many provide continuity of care. Many of them focus on teamwork across professions and disciplines. They all involve expert nurses working to full scope of practise, and many of them provide stronger support for existing staff on the ground.

The projects, all target groups whose needs are under served. Sometimes because of their location. For example, the Torres and Cape Islands HHS nurse practitioner innovation project. Project lead Doune Heppner. Sometimes because of a former reluctance to, or inability to access the mainstream services. For example, Metro South Maternity Hub. Project lead Michelle O'Connor. Sometimes because of stigma. For example, Metro North Scott programme shared care for opioid treatment. Project lead Peter Cochrane. And sometimes because the service has never before been available. For example, West Moreton HHS bowel and breast screening project for inmates. Project lead, Sarah Hesse.

All of the projects are designed to improve access to care. Some of the access was improved digitally, either through an app. For example, Townsville HHS Pregnancy on Palm. Project lead Jane Connell. Or, Northwest HHS wearable device at home. Project lead Adebimpe George. Some of the access was improved through new services being introduced into the community. Such as, Townsville HHS, public health nurse, providing STI testing to GP's. Project leads, Edith Torricke and Sue-Ellen Day. The Darling Downs HHS child development project, leading to reductions in waiting time for child development assessment from 18 months to two weeks. Project leads Nicole Stephenson and Natalie Rummell. And, the Central Queensland HHS chronic wound management into the community. Project lead Claire Letts. Other services were designed to improve access to in-hospital care. Such as, Metro Norths improved access for displaced patients waiting in ED, through introducing nurse practitioners who were able to provide full occasions of service. The triage categories, two to five. Project lead Andrea Hetherington. Many of the projects are deeply committed to culturally and emotionally appropriate care. This extends from one end of the state to the other, and it's particularly reflected in the number of projects relating to infant and maternity care. For example, in addition to the projects already mentioned the Gold Coast HHS birthing on country and first thousand days. Project lead Cassandra Nest. The Townsville HHS midwifery community access project. Project lead Audra Davis. The West Moreton enhanced Aboriginal and Torres Strait Islander infant and maternal care. Project lead Gwen Blom. In relation to its refugee population, the Darling Downs HHS have introduced a nurse navigator for refugee health who addresses cultural, linguistic and educational programmes to improve access to care. Project lead Heather Roberts. In relation to emotionally appropriate care, Metro North HHS run a project that educated staff about the need to be aware of the presence of trauma in acute psychiatric presentations and to provide trauma informed care. Project leads Lucinda Burton, Laura Freeburn and Melanie Sullivan.

The third over arching patient outcome is also a huge benefit to the hospital and health service. As it relates to the avoidance of hospital admission, through timely access to care and appropriate care in the community. This can be seen in the examples given above relating to timely access to care. However, two other areas where this has been highly successful, in this project, is in it's mental health and dementia care. The Gold Coast mental health and specialist services, and the Gold Coast local ambulance service network, undertook a project to address the immediate needs of patients experiencing a mental health crisis by introducing a co-responder model of care. Project lead Nicki Filauer. And the Sunshine Coast HHS introduced an emergency department mental health nurse practitioner, who was actually embedded in the community, to address community clinical complexity and unmet consumer need. Project lead Rob Leerentveld. Cairns and Hinterland HHS introduced the programme designed to enable local rural facilities to manage their dementia patients more skillfully, and with greater understanding. Thereby, reducing inter-hospital transfers Project lead Sussan Conway.

The last, but by no means least, overarching patient outcome that I identified, was the commitment where possible to continuity of care. Which is well demonstrated to improve patient maternal and child outcomes. Perhaps some of the most ambitious statewide schemes in relation to this was the Queensland children health network project, to transition patients with long standing chronic illnesses from the children's care team to the adult care teams across the state. Project lead Samantha Morgan. However, there were also many continuity of care models being run through midwifery services. Examples already mentioned include Gold Coast HHS, Metro South HHS, Townsville HHS, and West Moreton HHS. Metro North's Scott programme and the chronic wound programmes run by Central Queensland, also provide excellent examples of continuity of care. I identified three important and positive outcomes relating to the Queensland's health workforce. The first of these was the way in which all these nurses and midwives, be they navigators, clinical consultants or practitioners, made sure that wherever possible teamwork was involved. I think this is a really important message for those within the medical profession, who have in the past expressed concerns that expert nurses and midwives might work in isolation if given the funding and the freedom to do so. In fact, these expert nurses and midwives worked with general practise, with ambulance services, with medical and nursing specialists and generalists with allied health and with ancillary staff. They shared both the education programmes and their clinical expertise, generously and freely to anyone who sought it.

Perhaps for me, one of the most exciting, workforce outcomes is to see these highly skilled nurses and midwives being able to work to full scope of practise, without opposition or interference and demonstrating that when allowed to do so, the care for marginalised and underserved patient populations is measurably improved. I have spent my career fighting for the recognition, regulation and remuneration of our experts, clinical nurses, and midwives. And it is wonderful to have this concrete evidence of the difference nurses and midwives can make, when enabled and empowered to work to full scope of practise. Although, it relates to the first and second workforce outcomes, the third outcome identified was the obvious support these expert nurses and midwives were able to give to their other nurses and midwifery colleagues on the ground. For example, the nurse practitioners working on the outer islands of the Torres and Cape Hospital and health service, provided great support to the remote area nurses already working there. With a reduction in turnover of remote area nurses and the reduction in feelings of professional and social isolation for them. Only to say thank you to all of you who have been involved in these EB10 innovation project grants. I am inspired and heartened by the fantastic outcomes you have achieved both clinically and professionally. My sincere congratulations to, to all of the sponsors, the executive directors of nursing and midwifery and other supporting organisations, your vision and commitment to these projects. I understand a number of these roles are now embedded in the respective HHS's and that is wonderful news. Thank you all once again for the privilege of being involved. I hope that you found these presentations from the nursing and midwifery innovations series informative. Please take the time to check out the website so that you can see all of the other fantastic nursing and midwifery initiatives. Thanks so much.

Last updated: 24 November 2021